Abstract
The term neurologic symptom usually relates to the loss of motor or sensory functions;
cognitive deficit is mostly unrecognized in patients with severe carotid stenosis.
In large population studies carotid stenosis has been shown as independent risk factor
for mild cognitive impairment (MCI) and it was not due to underlying vascular risk
factors. The term MCI refers to a transitional stage between cognitive changes of
normal aging and vascular dementia. At this stage, cognitive decline is not severe
enough to constitute dementia, but also it is beyond the cognitive functioning deficit
which is expected in normal aging. Carotid stenosis detected in population older than
65 is 75% for men and 62% for women, with prevalence of stenosis ≥50% in this population 7% for men and 5% for women. There are two possible underlying
pathomorphological mechanisms of cognitive changes in patients with carotid disease
— cerebral emboli and hypoperfusion with or without silent brain infarctions. In both
cases loss of regional cerebral autoregulation can be recognized by means of neurosonology
(transcranial Doppler ultrasonography). Most of the studies which evaluated cognitive
functions before and after CEA/CAS have shown improvement or no changes in cognitive
functions, but no deteriorations. There are still no clear recommendations about using
CEA/CAS in treating cognitive deficit in otherwise asymptomatic patients. It is important
to recognize cognitive changes as a symptom of carotid disease in order to follow
up such patients and include cognitive deficit as one of the criteria in calculating
perioperative risk and benefit from CEA/CAS.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnostic tools for the study of vascular cognitive dysfunction in hypertension and antihypertensive drug research.Pharmacol Ther. 2006; 109: 274-283
- Progression of mild cognitive impairment to Alzheimer's or vascular dementia versus normative aging among elderly Chinese.Curr Alzheimer Res. 2005; 2: 571-578
- Mild cognitive impairment can be distinguished from Alzheimer's DISEASE and normal aging for clinical trials.Arch Neurol. 2004; 61: 59-65
- Atherosclerosis, apolipoprotein E and prevalence of dementia and Alzheimer's disease in the Rotterdam study.Lancet. 1997; 349: 151-154
- Vascular risk factors, incidence of MCI, and rates of progression to dementia.Neurology. 2004; 63: 1882-1891
- Diagnosis profile and comparison of risk factors in major types of dementia: a hospital base study.J Neurol Sci. 2004; 21: 4-8
- Vascular risk factors and intensity of cognitive dysfunction in MCI.J Neurol Sci. 2007; : 1-8
- Transcranial and extracranial ultrasound assessment of cerebral hemodynamics in vascular and Alzheimer's dementia.Neurol Res. 2006; 28: 645-649
- Assessment of subtle cognitive impairment in stroke-free patients with carotid disease.Acta Clin Croat. 2009; 48: 231-240
- Carotid stenosis and cognitive function.J Neurol Sci. 2009; 283: 36-40
- Cerebrovascular reactivity and cognitive decline in patients with Alzheimer disease.Stroke. 2006; 37: 1010-1015
- Breath holding index in detection of early cognitive decline.J Neurol Sci. 2010 Dec 15; 299: 116-119
- How to monitor vascular aging with an ultrasound.J Neurol Sci. 2007; : 1-9
- The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.J Am Geriatr Soc. 2005; 53: 695-699
- Clinicopathological analysis of dementia disorders in the elderly — an update.J Alzheimers Dis. 2006; 9: 61-70
- Alzheimer disease: focal cortical changes shown by positron emission tomography.Neurology. 1983; 33: 961-965
- Longitudinal studies of regional cerebral metabolism in Alzheimer disease.Neurology. 1988; 38: 909-912
- Evaluation of aging vs dementia by means of neurosonology.J Neurol Sci. 2009; 283 (Aug): 9-12
- Breath holding index and arterial stiffness as markers of vascular aging.Curr Aging Sci. 2010; 3: 67-70
- Pulse pressure and risk of Alzheimer disease in persons aged 75 years and older: a community-based, longitudinal study.Stroke. 2003; 34: 594-599
- Relationship between arterial stiffness and cognitive function in elderly subjects with complaints of memory loss.Stroke. 2005; 36: 2193-2197
- Arterial stiffness independently predicts cardiovascular events in an elderly community. Longitudinal Investigation for the Longevity and Aging in Hokkaido Country (LILAC) study.Biomed Pharmacother. 2005; 59: S40-S44
- Arterial stiffness is an independent risk factor for cognitive impairment in the elderly: a pilot study.J Hypertens. 2005; 23: 1211-1216
- Arterial stiffness as an independent predictor of longitudinal changes in cognitive function in the older individual.J Hypertens. 2007; 25: 1035-1040
- Carotid intima-media thickness (IMT): a surrogate marker of atherosclerosis.Acta Clin Croat. 2006; 45: 45-51
- Common carotid artery intima media thickness and post-stroke cognitive impairment.J Neurol Sci. 2004; 223: 129-134
- Carotid intima-media thickness and cognitive decline: what does it mean for prevention of dementia?.J Neurol Sci. 2004; 223: 103-105
- Carotid intima-media thickness and cognitive function in elderly women: a population‐based study.Neuroepidemiology. 2007; 28: 207-213
- European Stroke Initiative (EUSI) recommendations for stroke management.Eur J Neurol. 2000; 7: 607-623
- The NASCET — surgical results in 1415 patients.Stroke. 1999; 30: 1751-1758
- Reanalysis of the final results of the ECST.Stroke. 2003; 34: 514-523
- Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial.Lancet. 2004; 363: 1491-1502
- Impairment of Cerebral Vasoreactivity (CVR) in Multiinfarct Dementia (MID), Dementia of Alzheimer's type (DAT), and Dementia in Parkinson's Disease (DPD).Period Biol. 1995; 97: 99-104
- Breath holding index in evaluation of cerebral vasoreactivity.Acta Clin Croat. 2006; 34: 1645-1649
- Transcranial Doppler Sonography during visual stimulation.Acta Clin Croat. 1999; 38: 285-288
- Differentiation of vascular dementia and Alzheimer disease: a functional transcranial Doppler ultrasonographic study.J Ultrasound Med. 2005; 24: 1065-1070
- Cerebrovascular reactivity in degenerative and vascular dementia: a transcranial Doppler study.Eur Neurol. 2007; 58: 84-89
- Interaction of cardiovascular disease and neurodegeneration: transcranial Doppler ultrasonography and Alzheimer disease.Neurol Res. 2006; 28: 672-678
- Cerebral emboli as a potential cause of Alzheimer's disease and vascular dementia: a case–control study.BMJ. 2006; 332 (13): 1119-1124
- Are spontaneous cerebral microemboli consistent in carotid disease?.Stroke. 2002; 33: 685-688
- Cerebral injury during cardiopulmonary bypass: emboli impair memory.J Thorac Cardiovasc Surg. 2001; 121: 1150-1160
- Microemboli in cerebral circulation and alteration of cognitive abilities in patients with mechanical prosthetic heart valves.Stroke. 1998; 29: 1821-1826
- Occurrence of transcranial Doppler high-intensity signals in patients with potential cardiac source of embolism: a prospective study.Stroke. 1995; 26: 2067-2070
- Asymptomatic spontaneous cerebral emboli predict cognitive and functional decline in dementia.Biol Psychiatry. 2007; 62: 339-344
- Recommendations for the management of patients with carotid stenosis.Acta Clin Croat. 2010; 49: 118
- Treatment of vascular dementia.Dement Neuropsychol. 2011; 5: 275-287
- Neuropsychological consequences of endarterectomy and endovascular angioplasty with stent placement for treatment of symptomatic carotid stenosis.J Neurol. 2007; 254: 1524-1532
- Carotid endarterectomy and gliofibrillar S100b protein release.Neurol Sci. 2003; 24: 351-356
- Transient changes of brain-derived neurotrophic factor (BDNF) mRNA expression in hippocampus during moderate ischemia induced by chronic bilateral common carotid artery occlusions in the rat.Mol Brain Res. 2001; 1664: 351-356
Article info
Publication history
Published online: August 27, 2012
Accepted:
July 5,
2012
Received in revised form:
June 20,
2012
Received:
February 2,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
